1. Nursing Challenges in CRRT Margaret Farley RN

2. CRRT Staffing  Need to try and project how many children may require CRRT annually in your unit  Develop and grow your team size with this number in mind- want to avoid either staff burn out or staff unable to access sufficient CRRT hours to support them in developing competence and confidence.  Have two full day of study – mornings for theory and afternoons for Water Labs  Governance requirement to monitor and document individuals acquisition of CRRT related skills using some form of competency chart  Desirable to provide some individual 1:1 preceptorship for trainees in the clinical arena

3. CRRT nurse role  Early identification of children needing CRRT  Rapid response aiming to initiate treatment within an hour of identifying the need for CRRT  We currently have wet primed CRRT circuits prepared and ready to go 24/7  Where there are 2 or more children in PICU on CRRT have a dedicated CRRT nurse to support the bedside nurse in ensuring prescription is achieved reliably and accurately  Support in ensuring patient ACT monitored closely to protect/prolong circuit integrity  Education of the bedside nurses and the less experienced medics  Monitoring and management of hardware and stock levels

4. Staffing – Top Tips  Aim to have a nurse lead for the CRRT service, when you have a named individual taking responsibility for service delivery and education things should run more smoothly – hopefully  Keep treatment delivery SIMPLE to reduce the risk - You don’t need a wide range of haemofilter, pick two one large and one small -Keep your circuit sizes simple one large, one small -Look at the range of treatments you deliver to the average run of the mill patient SCUF/CVVH/CVVHD/CVVHDF - Really !! See the rule above and pick two. Currently we use CVVH and CVVHDF